Back to CPAP square one!

[clenchingtobreathe]

Just as I had reached the 3 month mark with my Airsense 10, I thought I was beginning to adapt. Then I switched to the For Her model and things got worse....pressure riding high all night...ergo: mouth leaks. THEN last week I got braces on my teeth and all sleep is lost. Constant mouth leaks and precious little sleep.
Ordered a DreamWear FFM. It seems to control the mouth leaks, but I have no idea if I'm wearing it too tightly or not. The headgear that attaches the mask sits at the base of my head and I cannot even look up while wearing it. It causes my neck to snap and pop uncomfortably at the base of my head. The mask seems to leak every time I change positions...which, of course, wakes me up. And the mouth portion when snug has a tendency to make my jaw achy.
I have increased my pressure over time to 7 cm up to 10 cm with an EPR of 2. The AirSense 10 did not ride the highest pressure line like the For Her does and I'm tempted to change back.
Any suggestions about the FFM? And pressures?
This is last night's SH report. AHI is low because I hardly slept. I also changed from the FFM to the nasal cushion about 3am.
I am really, really tired.

[Julie]

If it feels too tight, uncomfortable, then it is too tight... the cushion needs to inflate to work properly and if things leak beyond little bits, you may need either another size, better adjustment or another mask (I know it's expensive!). Play with adjustments for a few nights, EPR, bed pillows, etc and change only one thing at a time whether it's those, or pressures, etc. so you can see what works or not. And of course don't take nondrowsy allergy pills before bed (I mention that because I did it and then went into a crazy cycle of those + melatonin, etc. until things worked well. You'll get there, but it's too bad it's taking so long.

[Pugsy]

My personal opinion right now....sleep is your primary goal because if you aren't sleeping then of all this therapy stuff doesn't really matter much does it?
Until you are actually sleeping for decent blocks of time it is impossible to even remotely come up with pressure ideas for therapy effectiveness.

Plus it's common to need even more pressure when using a FFM compared to a nasal mask because those lower straps can alter the airway position a bit.
And if you have the lower straps so tight you can't look up....way too tight.

What would it take for you just to sleep in terms of mask comfort? Forget pressure needs for the moment...just mask comfort because if you aren't comfortable with a mask you aren't going to sleep well at all.

[clenchingtobreathe]

What would it take for you just to sleep in terms of mask comfort? Forget pressure needs for the moment...just mask comfort because if you aren't comfortable with a mask you aren't going to sleep well at all.

I feel pretty certain that I am never going to be one of those folks who love their masks. I am ALWAYS aware of its presence on my face. I had become fairly comfortable with the DW Nasal Cushion with pressures between 6.6-7.0 low...and 9.0 - 9.4 high before braces and using the Airsense 10 instead of the For her. Mouth leaks are always the big culprit as every tiny one wakes me up and then I struggle with getting back to sleep. One night, I dropped the high pressure to 9.0 and slept the best so far....but ended with an AHI of over 3.

When I loosened the FFM to something that felt "comfortable," it gurgled and farted and squeaked and whistled until I just had to take it off. However, the fit around my mouth does keep the mouth leaks at bay.....

I guess I am clueless about what might be helpful. I fantasize about sleeping with nothing on my face....but then I remember I wasn't breaking any sleeping records before I started this.

[clenchingtobreathe]

If it feels too tight, uncomfortable, then it is too tight... the cushion needs to inflate to work properly and if things leak beyond little bits, you may need either another size, better adjustment or another mask (I know it's expensive!). Play with adjustments for a few nights, EPR, bed pillows, etc and change only one thing at a time whether it's those, or pressures, etc. so you can see what works or not. And of course don't take nondrowsy allergy pills before bed (I mention that because I did it and then went into a crazy cycle of those + melatonin, etc. until things worked well. You'll get there, but it's too bad it's taking so long.

Thank you for the encouragement. I am a size small in all areas of my mask! A medium hangs off my face! HA! I bet that would be more comfortable though! I will keep tinkering as you suggest. The braces just threw a big monkey wrench into an already difficult process for me. It's like starting over and I feel pretty low today.....

[Grace~~~]

Hi CTB ~~~

As I mentioned before, I did braces with the dreamwear nasal mask.

I never thought to focus on finding a new mask, I focused on making the braces more comfortable so I could wear the DW mask that I liked.

1) Your dentist/orthodontist can make you a retainer cover.
2) You can use wax and other numbing products
3) You could try something like this:

https://www.dentakit.com/comfortbrace.h ... gID0vD_BwE
or
https://www.amazon.com/COMFORT-LIP-SHIE ... B00H2S7TC0

Your mouth WILL "toughen up" a bit too.
I just want to encourage you to try to solve this problem from both angles.

Fingers Crossed

...and try those colored bands when you get to that point! LOL
Pretty.

[freetimecreations]

What would it take for you just to sleep in terms of mask comfort? Forget pressure needs for the moment...just mask comfort because if you aren't comfortable with a mask you aren't going to sleep well at all.

One night, I dropped the high pressure to 9.0 and slept the best so far....but ended with an AHI of over 3.


I guess I am clueless about what might be helpful. I fantasize about sleeping with nothing on my face....but then I remember I wasn't breaking any sleeping records before I started this.

When I started out I often limited my high pressure because of mask leaks and being woken up by the higher pressures. My thought at the time and I believe that Pugsy is suggesting to you that a full 8 (In my case) hours sleep is more important than the lowest AHI possible. Your AHI of over 3 is treated apnea but maybe not optimized but like you said, best sleep so far.

[Pugsy]

I believe that Pugsy is suggesting to you that a full 8 (In my case) hours sleep is more important than the lowest AHI possible.

Yeah, sort of and I wouldn't go so far as to hope for 8 hours...that's extremely wishful thinking. Heck, even for me that is wishful thinking right now...other issues going on unrelated to mask or sleep apnea. Right now I am thrilled if I can get just 6 hours and not have it too heavily fragmented.

One night, I dropped the high pressure to 9.0 and slept the best so far....but ended with an AHI of over 3.

Then that's what I would go back to for now anyway and quit worrying about the AHI at all.
Which do you think would let you feel the best....AHI of 0.0 and no sleep like last night or AHI of 4 and maybe 6 hours of fairly solid sleep?
Kind of a no brainer in my book.
Just because the machine may want to go higher doesn't always mean that we just have to let it go higher if the going higher causes more problems than it is fixing when it does go higher.

Use the mask you hate the least... the one that you can at least sleep with. No, none of them are perfect..or at least I still haven't found one that is after over 9 years and dozens of mask trials over the years. I pick the one that I hate the least and I still can't say that "I love my mask" because I don't. I would still rather not wear one at all but that's an option I don't dare choose so I do what I have to do and make whatever compromises I have to make just to get the sleep first and then I worry about the nit picking on the details.

The best numbers in the world don't mean a hill of beans if you simply can't get some decent sleep.
Go back to the mask you hate the least...use the settings that at least let you sleep and get used to the braces and all that other stuff and then let's worry about the AHI and the leaks or whatever later. You are trying to do too many new things at once and it simply is too difficult.
Use the nasal mask because it seems to be the most comfortable...if you mouth breathe a little...it's not the end of the world if you do.
The end of the world is when you report a night like you did last night where essentially you just didn't get much sleep at all and probably feel like total crap today. Not worth it to try to just get "better numbers" and I am betting some of that AHI of 3 probably wasn't real apneas anyway.

Use the pressure settings that worked in the past that you could sleep with...if the machine wants to peg out at 9 cm all night but you sleep good...I take good sleep quality any day of the week. If you want to change out of the for Her mode to the other regular mode...change it out. Or heck, even give 9 cm fixed a try because the machine wants to go there anyway.
Is it "ideal"..probably not if just looking at the numbers but again...the best numbers in the world don't mean squat if you don't sleep.

This stuff is hard enough without new monkey wrenches being thrown in to muck up things...now you have braces added in to an already far from ideal situation.

Back up and target primary goals first...the the main one is sleep because if you can't sleep none of this other stuff really matters.
Tackle one known problem at a time. Quit trying to fix everything all at once.
Use the mask you hate the least.
Use the pressure settings that at least let you sleep for quite a bit of the time.
Deal with the braces as best you can.
Get some sleep first...later we can try to fine tune things if needed.
If you mouth leak a bit...shrug your shoulders and move on. Unless you spend half the night mouth breathing with leaks well above 40 L/min...far from being the end of the world and I am betting the mouth breathing leaks probably are not all that huge or prolonged anyway.

Sleep....primary goal because if you don't sleep the rest of all this crap doesn't matter much.

[clenchingtobreathe]

Hi CTB ~~~

As I mentioned before, I did braces with the dreamwear nasal mask.

I never thought to focus on finding a new mask, I focused on making the braces more comfortable so I could wear the DW mask that I liked.

I have taken your advice.THANK YOU! Using lots of good wax and have gotten past the first painful days. The braces for some reason just let my lips slip open and then I have to deal with the mouth leaks that disturb my sleep so badly. Thanks for the encouragement!

[kteague]

Have you tried mastering the technique of using suction to seal your tongue against the roof of your mouth? Especially now that you're dealing with braces it seems your best bet is to stop the air before it gets to your lips. It took me months to master it but at some point it bacame second nature. Good luck with things.

[clenchingtobreathe]

I believe that Pugsy is suggesting to you that a full 8 (In my case) hours sleep is more important than the lowest AHI possible.

Back up and target primary goals first...the the main one is sleep because if you can't sleep none of this other stuff really matters.
Tackle one known problem at a time. Quit trying to fix everything all at once.
Use the mask you hate the least.
Use the pressure settings that at least let you sleep for quite a bit of the time.
Deal with the braces as best you can.
Get some sleep first...later we can try to fine tune things if needed.
If you mouth leak a bit...shrug your shoulders and move on. Unless you spend half the night mouth breathing with leaks well above 40 L/min...far from being the end of the world and I am betting the mouth breathing leaks probably are not all that huge or prolonged anyway.

Sleep....primary goal because if you don't sleep the rest of all this crap doesn't matter much.

Thank you once again, Pugsy, for your sensible words. I have been trying so hard to do all this new stuff right that I have just worn myself out physically and emotionally. I will take your advice. I will go back to using my DW nasal cushion (the mask I hate the least! ) and put a lid on the high pressure for awhile and see what happens.
I'd pay good money for a restful 8 hours of sleep but, like you, I am battling sleep on a variety of fronts....and if I can get 4 straight hours in a row at night without remembering several arousals, I am grateful!
I can't tell you how much I appreciate your knowledge and the support of all those on this forum who have a LOT more experience with this than I do!

[clenchingtobreathe]

Have you tried mastering the technique of using suction to seal your tongue against the roof of your mouth? Especially now that you're dealing with braces it seems your best bet is to stop the air before it gets to your lips. It took me months to master it but at some point it bacame second nature. Good luck with things.

I have tried for months now. I do really well until the pressure goes over 9cm.....then my poor little tongue just flakes out!

[zonker]

hi, clench! i'm so sorry you are having such a rough time. but i'm glad you are getting helpful advice.

i have nothing to add in that department. i just want to give you a note of encouragement. you WILL get past this and then on to master your apnea. no doubt about it.

you are one of the most cheerful and determined people who i've ever come across in this forum!

hang in there and good luck!!

[clenchingtobreathe]

Back up and target primary goals first...the the main one is sleep because if you can't sleep none of this other stuff really matters.
Tackle one known problem at a time. Quit trying to fix everything all at once.
Use the mask you hate the least.
Use the pressure settings that at least let you sleep for quite a bit of the time.
Deal with the braces as best you can.
Get some sleep first...later we can try to fine tune things if needed.
If you mouth leak a bit...shrug your shoulders and move on. Unless you spend half the night mouth breathing with leaks well above 40 L/min...far from being the end of the world and I am betting the mouth breathing leaks probably are not all that huge or prolonged anyway.

Sleep....primary goal because if you don't sleep the rest of all this crap doesn't matter much.
[/quote]

Pugsy, I have done as you advised!! I went back to my DW Nasal Cushion. I dropped the max pressure to 8.8...kept low pressure to 7. I was still troubled with lots of mouth leaks, so I set the EPR back from 2 to 3 and that stopped MUCH of the mouth filling and leaking. I'm using a little tape on my lips to help them close around the braces so my mouth won't get dry from leaks. And guess what? My AHI is averaging about 1.6 for the last week and I am resting a good bit better as a result!! I still have other issues to deal with (like teeth clenching & stuffy nose ) but you have helped me solve the BIG problem for the time being and I can't TELL you how much I appreciate it! I'm going to give this another week or so and then I'll post a SH report for your review. Just wanted you to know how much you helped me get on track!

[Pugsy]

Glad to hear that going back to the basics has helped.
Good job.

Now let's hope I can get more sleep tonight myself...been fighting my own demons lately.
The only thing cpap related though....condensation in the mask and hose with the cooler temps lately. I didn't adjust the heated hose temp upwards soon enough. Fixed that a couple of nights ago.
The other non cpap stuff...it's a crap shoot every night. I used to average nearly 8 hours every night..now I can't even seem to average 6 hours (and those hours are fragmented at that which sucks) and I definitely feel it. I am a tired grouchy old bitch.